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Pyloric sphincter is the opening between the lower portion of the stomach and the beginning portion of the intestine (duodenum). If there is hypertrophy (increase in size) or hyperplasia (excessive proliferation of normal cells in normal tissue) of the muscle surrounding the sphincter, there will be problems with the stomach emptying called pyloric stenosis. At 4-6 weeks of age, infants begin to vomit with feeds. Vomiting grows increasingly forceful until it is projectile; can project up to 3-4 feet (this is the most common symptom). Occurs most frequently in first born white males. o 1:150 males o 1:750 females Cause is unknown, but is probably inherited Vomitus usually smells sour (because of increased gastric acid) Diagnosis of pyloric stenosis Made primarily from history When the parent says their infant is vomiting, we need to find out: o What is the duration, intensity, frequency, description of vomitus o Is the infant ill in any other way? o Many infants show signs of dehydration at the time of diagnosis. A definite diagnosis is made by watching the infant drink; there is usually an olive-sized mass in the right upper quadrant which becomes more prominent with drinking the water (seen on the outside of the body). May also confirm with ultrasound Therapeutic management of pyloric stenosis Surgical correction: pyloromyotomy o Muscle of pylorus is split allowing for a larger lumen o Is usually done laparoscopy o Prognosis is excellent Nursing care postoperatively for pyloric stenosis: Feedings usually begun 4-6 hours post-op with 1 tsp (5 ml) of 5% glucose in saline hourly by bottle for four feeds If no vomiting, 2 tablespoons given hourly for the next four feeds Next, half-strength formula is given every 4 hours By 24 to 48 hours, infants are taking their full formula diet or being breastfed. Usually discharged after 48 hours. Do not give more fluid than ordered; risks for breaking open the newly operated areas. IV fluids decreased as oral amount increases Infants need to be bubbled/burped well after each feeding to decrease swelling; we don’t want air or gas to be in tummies Lay them on their side, preferably right side, to aid the flow of fluid through the pylorus via gravity Monitor daily weights
Usually no vomiting occurs after the surgery. If it does. Some infants experience diarrhea due to the rapid functioning of pyloric sphincter Elevate the head of the bed Monitor intake and output carefully. report immediately! Feeding regimen may need to be adjusted. weigh all diapers Nursing care for the pyloric sphincter incision Care of the operative site: o Observe for any drainage or signs of inflammation o Care of incision as dictated by hospital policy o Keep diaper folded low to prevent contamination of incision o Change diapers frequently .